Do Opioids Alone Have an Impact on Life Expectancy? – By Lynn Webster, M.D. – Sept 2017
Dr. Webster presents us with examples of two kinds of people having two different motivations for opioid use. For one group, the drug increases their quality and length of life, while for the other, illicit opioids decrease quality and length of life:
- one is using carefully measured, quality assured opioids from a pharmacy “as prescribed” as part of a medical treatment plan,
- the other is using various amounts of various combinations of various opioid-laced powers acquired from illicit sources.
That right there explains why overdoses are far less likely to happen in legitimate pain patients.
Meet Rachell and Lorna. They are very different women, but they have one thing in common: they both used opioids.
While Rachel never turned to heroin or other street drugs, she used prescription opioids for non medical reasons.
After seventy-six-year-old Lorna awoke, she rolled over to sit up, and a severe bolt of lancinating pain radiated down her right leg into her foot. Lorna had to have an emergency lumbar discectomy to remove the herniated disc pressing on her L4 nerve root.
After the operation, she continued to experience moderate pain but small amounts of opioids made the pain tolerable.
Rachel and Lorna’s needs for an opioid were rooted in entirely different situations.
Rachel began receiving pain medication for normal surgical pain but, because of her genetics and environment, she continued using opioids for the wrong reasons.
Lorna’s need for opioids was more rudimentary: she used them so that she could perform the normal activities of daily living.
Rachel and Lorna represent two different worlds that are often conflated when policies are enacted to curtail the opioid crisis.
Recently, the Washington Post wrote, “America’s opioid problem is so bad that it’s cutting into the U.S. life expectancy.” This is a troubling statement.
- Sometimes, pain is chronic.
- Chronic pain is a chronic illness.
- Chronic illnesses, generally, are associated with shorter life spans.
In fact, life expectancy decreases with each additional chronic condition.
The average decline in life expectancy is 1.8 years with each additional chronic condition ranging from 0.4 fewer years with the first condition to 2.6 fewer years with the sixth condition. These results are consistent across gender and race.
People in severe chronic pain generally have multiple other co-morbid medical illnesses. Therefore, it’s unsurprising that life expectancy for people in chronic pain has been reported to be 10 years less than for the general population.
The claim that opioids reduce life expectancy needs to be closely examined in context. It is important to understand how the illicit use vs. the legitimate use of opioids is contributing to the problem.
To further complicate matters, people who are prescribed opioids because of chronic pain may, in fact, live longer than people with chronic pain who don’t use opioids.
The above will probably only make sense to those of us with chronic pain because it seems too counterintuitive for the average person to comprehend.
The failure to appropriately treat chronic pain probably has an adverse effect on life expectancy.
Yet, even as chronic pain is acknowledged as being a factor in national life expectancy, all we’re getting are useless self-aggrandizing “statements”, “committees”, and “task forces”, while our pain remains ignored by concrete actions.
Meanwhile, vast resources (and tax dollars) are spent to reduce opioid prescribing, no matter how long it’s been working or how effective it is, just because the illicit drug people are overdosing on (heroin, fentanyl) is in the same pharmaceutical class (opioid) as our prescribed pain medication.
Suicide and People With Chronic Pain
One reason for this is suicide.
People with chronic pain are at least three times more likely to die of suicide than the general population. Suicides have reached an all-time high in the United States. In 2015, more than 44,000 suicides occurred.
This figure is about 3 times greater than the number of people who died for reasons related to prescription opioids.
I’ve posted many articles on the subject of suicide., especially among desperate pain patients when denied their only source of relief.
Recently, it was reported that suicide was 7 times more likely to be the cause of death in the elderly population with severe pain than it was for the seniors who were not experiencing severe chronic pain.
The number of suicides related to severe pain in the elderly population was more than the number of suicides associated with psychiatric disorders, depression, or anxiety disorders. Only bipolar disease created a greater risk of suicide.
That said, because of their illnesses, even those who treat their pain with opioids will likely have shorter lifespans than the general population. That’s generally true for people who take medication for any chronic illness.
Medications Come With Risks
It’s a fact that people with chronic illnesses usually take medication for their illnesses. Unfortunately, despite the medication, most people with chronic illnesses statistically die earlier than those who do not have chronic illnesses.
Concluding that anyone who uses an opioid has a shorter life expectancy because of the opioid is not only inaccurate, but it’s counterproductive to our society’s shared mission of reducing harm from opioids.
It is as erroneous as relating the treatment of cancer to the premature deaths of people with cancer.
This is a common claim these days:
“when people take opioids for coninued cancer pain even after successful treatment, the opioids are blamed for their shortened life span, not the cancer, not the radiation, not the chemotherapy used for treatment.
This is an egregious error being propagated by anti-opioid zealots.